Impact of a Targeted Fluoroquinolone Restriction on Antimicrobial Usage at Two Community Hospitals

BACKGROUND: A broad spectrum of activity and excellent oral bioavailability have made the fluoroquinolone (FQ) drug class the first-line option for treating various inpatient and outpatient infections. These advantages have resulted in overuse of FQ, resulting in wide-spread resistance to FQ, increasing reports of adverse effects, and superinfections. The Food and Drug Administration (FDA) issued an updated Boxed Warning for FQ antibiotics in July of 2016 to warn of serious and possibly permanent adverse effects. It also warned against the use of FQ to treat infections when other treatment options are available. In response to these strengthened warnings, our system implemented a protocol for FQ prescribing. This study was performed to determine the effects of this protocol on FQ usage and patient outcomes at two community hospitals in our system. METHODS: This is a multi-center pre-post observational cohort study conducted to analyze the impact of a FQ restriction protocol on FQ utilization in two acute care community hospitals. The FQ protocol was developed by our Antimicrobial Stewardship (AS) Team and approved by the Pharmacy and Therapeutics Committee. It was distributed to all medical staff, and the AS Team performed physician and staff education. A pharmacist reviewed all orders for FQ to determine whether the patient met criteria for the use of the FQ or not. If criteria were not met, the physician was contacted and alternatives discussed. The AS team provided one-on-one education as needed. RESULTS: Over the first four months of the implementation of the protocol, our hospitals saw a reduction of total FQ use from 357 days of therapy per 1000 patient days at risk (DOT) at baseline in 2016 to 101 DOT in 2017 (71.7% reduction, P < 0.001). Preliminary readmission rates for patients treated for urinary tract infection and for diverticulitis were similar between time periods, and C. difficile rates decreased. CONCLUSION: Our study demonstrated a significant reduction in FQ utilization as a result of a targeted FQ restriction that helped guide physicians to appropriate alternative antibiotics. Preliminary data showed no increase in patient readmissions for the primary groups targeted by the protocol, and the hospitals’ C. difficile infection rate decreased, as well. DISCLOSURES: All authors: No reported disclosures.